Breast Cancer Treatments

Everyone is different ... my doctors told me not to expect any noticeable side effects from herceptin, however, I do have them.
My exhaustion levels are still so high. At first the doc blamed recovery from other chemo, but at this point believes it's the herceptin causing it.
Also, for about 2-3 days after infusion I have flu-like symptoms (very achey and sore and more tired). And for about a week I get taxol-recall joint pain.
That said, my doctors have said this isn't common BUT I have reacted strongly to everything we've done so far and they theorize that my body is just hyper-sensitive. Chances are you aren't and won't deal with it, but I share on the off chance you do get side effects, you're not crazy or imagining it!

The standard recommendation is for five years of aromatase therapy based on our present knowledge and the results of numerous large clinical trials that compared aromatase inhibitors to tamoxifen. It is also an acceptable strategy to initiate therapy with tamoxifen and switch to an aromatase inhibitor after 2 to 3 years to complete a total of five years of therapy. Based on evidence from a large clinical trial, it is also acceptable to switch to tamoxifen from an aromatase inhibitor; this is an option for individuals who are experiencing difficult side effects with aromatase inhibitors.

Typically it decided based on the results of clinical trials. We test different drugs with a large population of breast cancer patients and then whichever one is the most effective is the one that becomes the standard of care (i.e. the one that we choose first). If there are reasons why that person can’t tolerate that regimen then we may have to alter that plan. There may be sometimes where there are regimens that are equal and then it is based on side effects or logistics (how often the infusion ).

Interestingly, triple negative breast cancer (ER/PR/HER2 negative) is more than one disease. While some subsets reveal exquisite sensitivity to drugs like Cisplatin, other tumors may have features that render them better targets for agents that inhibit signaling pathways like AKT/mTOR. There may be other triple negatives for whom androgen therapy could hold benefit. Our experience with the Cisplatin/Gemcitabine doublet in this group, a regimen that we originally developed (Nagourney et al, J Clin Oncol 2000) is one example of good outcome with a appropriately selected chemotherapy.

The options for such patients have never been greater. They include continuing trastuzumab (Herceptin™) as the chemotherapy is switched, the substitution or addition of lapatinib for or with trastuzumab, and enrollment on clinical trials testing a large and growing number of HER2 directed novel therapies.

This is the beginning of a story. The gene set performed as a prognostic test well here. This needs to be confirmed but even more important is the need to demonstrate that it predicts, or does not predict, the benefit of radiation therapy for DCIS.

The drug is everolimus, an mTOR inhibitor, added to an aromatase inhibitor (exemestane, known as Aromacin). The months that it “seems” to buy are time until the cancer worsens. This is an important issue because it can be confused with survival (i.e., how long a patient lives) but it is actually not (yet) known to prolong this. It also has some real, but manageable toxicities. It represents confirmation that inhibition of mTOR can be clinically effective but the relative value of this approach and its optimal implementation remains to be more fully determined.

As a first approximation this is not really a concern. When chemotherapy (in general) is needed, the subtype of breast cancer does not have a reliable association with the benefits of individual drugs and regimens.

Olaparib was developed to specifically target PARP, which becomes more critical in cancers that develop as a consequence of an inherited mutation in the DNA-repair genes. Its activity is largely confined to those breast and ovary cancers that have defective BRCA genes on the basis of inheritance. It could similarly be active in other cancers, such as Pancreatic, that are associated with these genetic defects but more data is needed.

There is a small numerical advantage, on average, associated with the use of aromatase inhibitors over tamoxifen. However, that does not mean that every single patient must use the AIs. If the AIs are intolerable it is reasonable to use tamoxifen instead.

I was on the NASBP Protocol B-40. I was ramdomly put into the Groupe 3B where I first received Docetaxel combined with Gemcetabine for a period of 12 weeks witht he addition of Avastin. Then for another 12 weeks, I received AC with more Avastin. It was followed by a double mastectomy, including reconstruction with implants. Once done, I received 24 radio tx and 10 more injection of Avastin. What was so amazing, I had 4 tumors in my left breast who made a lump of about 2,5 inch diameter and several my lymph nodes were infected. Two tx into the b40 protocol, and my lump had diminished to the point where I didn't have any discernible lump during a manual eval. At mastectomy time, there was only an less than half-inch of cancer left in the breast.

It was incredible to see how fast I responded to chemo and how the combination with Avastin allowed to pratically melt my tumors away in so few tx.

This is a very controversial topics. Triple negative breast cancer does not mean automatically chemotherapy. The very very small tumors with no lymph node many not have an indication of chemotherapy depending on the patient's general health condition or age. So question is what is small small? This is where split opinions do exist. This is something that we can not truly discuss unless we see each case in the clinic.

This is a critical question. I found that the medical care and treatment were outstanding but that the "soft"side was not so much in place. I connected with 2 other women who had been diagnosed at a similar time and who were also treated in the same hospital. This was invaluable and we are still in contact and now try to ensure that our checks coincide.

To be absolutely honest though, a significant support network was online. I subscribed to two Breast Cancer sites, one UK and one US based. On one site I followed a thread of women who were going through chemotherapy at the same time and although we were at opposite sides of the planet our side effects brought us together. I was able to share highly personal details with a group of women, many of whom I did not know their name!

I also blogged throughout the experience (and still do). This was a great way of communicating what was happening to friends and family far away. However more than this, it enabled me to process everything I was going through. I also find that it has provided a detailed record and document of the experience. It was an important coping strategy.

There were distinct advantages of having my treatment overseas. I was able to continue working, for example. I had virtually no waiting time for treatments and had access to top medical care and facilities. As I mentioned earlier, the gap was on the support and "soft" side and I had to make more effort in this area to find the support I needed.

I have to say that during the whole treatment period I had the support (physical, emotional and practical) of my husband who was at my side throughout.

I think it was probably harder for my family than it was for me being overseas.

Unfortunately, there is no IBC specific chemotherapy for now. But in general, it is anthracycline (adriamycin, epirubicin) based or taxane (paclitaxel or docetaxel) based. For newly diagnosed IBC, both are used in sequence. Weekly paclitaxel followed by FAC (FEC) is our standard at MD Anderson Cancer Center IBC program.

Currently, there are no exception for the sequence of how the inflammatory breast cancer should be treated. The newly diagnosed inflammatory breast cancer without metastasis needs to receive systemic therapy (chemotherapy and/or targeted therapy), followed by surgery, and radiation. The surgery must be modified radical mastectomy. It is very important to see the IBC specialists.

There are currently two ways to do Accelerated Partial Breast Irradiation: AccuBoost (a precise form of high dose rate (HDR) brachytherapy done as part of a protocol or off-label use. It can be done twice a day for 5 days, or once daily for 10 consecutive days. The other form is done via external beam radiation therapy, typically intensity modulated radiation therapy, or IMRT.

Both you and your physician will be monitoring the potential risks of anastrozole.

The risks that may cause the most concern are:
- Decreases in bone mineral density (BMD). (Potential increase in bone loss.)
- May cause higher cholesterol levels or liver disease.
- Patient's with heart disease may have more of a chance to experience an ischemic cardiovascular event. (An ischemic cardiovascular event is reduced blood supply to the muscles of the heart).

The patient should be aware and notify the physician of any changes in how they feel, particularly paying attention to bone pain, chest pain, or liver pain (upper right quadrant).

The way to monitor these risks are through the following:
- bone density test
- complete blood cell counts (CBC)
- monitoring cholesterol and liver function tests
- thyroid function tests
- monitoring serum electrolytes
- kidney function, and blood pressure.


There will also be the physical assessment of the patient and monitoring for the postmenopausal women taking anastrozole. This will include blood pressure readings, pain assessment, gastrointestinal upsets, and hot flashes.

When initiating anastrozole treatment patients may experience dizziness and fatigue. Until your body adjusts be cautious before performing work that requires mental alertness, such as driving.

For more information, see the following link:
http://www.rxlist.com/arimidex-drug.htm

Anastrozole is indicated for:
- Treatment of hormone receptor-positive early and metastatic breast cancer in post-menopausal women. It may be used alone or after surgery or radiation. (Early breast cancer is cancer that has not spread outside the breast to other parts of the body.)
- Treatment of hormone receptor-positive breast cancer that has progressed after receiving tamoxifen treatment for post-menopausal women.
- Post-menopausal women where the ER-positive or hormone receptor unknown breast cancer has spread in the breast or to other parts of the body.

For more information, see the following link:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000982/

There is no dosage adjustment for patients taking anastrozole with normal liver function. The physician will monitor the patient's liver function and change medications if needed.
- For elderly post-menopausal women, there are no recommendations to change the dose.
- For patients with mild to moderate liver disease, as determined by liver function tests, there are no recommendations to change the dose.
- In patients with severe liver disease there have been no studies to conclude if the dose should be changed. The physician will decide whether to change medications.

For more information, see the following links:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000982/
http://www.drugs.com/pro/arimidex.html
http://www.rxlist.com/arimidex-drug.htm